now let's look at the nose and it's an area of high risk so it's very important that you know the vascular Anatomy before you inject and the vascular anatomy of the nose is highly variable so let's start with the nasal spine and that's right here so sometimes there's a midline artery along the nasal spine so let's take a peek in this patient and see so you do see that there is a vessel here but it's not on the bone where you're injecting in the nasal spine area so this patient checks out that a deep injection on the nasal spine is okay to give support to the nose so the other pertinent vessels are the dorsal nasal vessels which usually run paramedian but often they cross the midline and often they're communicating branches so you really have to evaluate the nose in several spots to get your anatomy and to get the layer because hopefully it's not along the bone and it's not in the midline so the best way to evaluate the nose is actually in a horizontal fashion and in this case you do an offset what does an offset mean and offet means that you put so much gel on the ultrasound that you're actually not touching the skin that lets you not apply any pressure to the vessels so you're not crimping them off so this is the area that I'm looking at I'm looking for the vasc so what we see here are the paramedian positions of the dorsal nasal artery so this would be the midline and you see the paramedian position of the arteries so this patient in this particular area which is in the radic area is a perfect candidate for injections in that area let's move down a little bit and look in the super tip area so what I'm seeing here is probably a branch of the lateral nasal artery so the lateral nasal artery is a branch of the angular artery and it comes just superior to the nasal AAR Groove and comes up here so you see that that's also a deep artery so but it's not recommended to inject too far off the midline for vascular risk
